Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...
Medical Genetics & Molecular Lab Billing
Genetic tests are expensive, heavily scrutinized and often need prior authorization. Specialist billers handle molecular codes, PLA codes and payer test-registration rules.
- Molecular pathology, genomic sequencing and PLA coding
- Prior authorization with clinical and family-history documentation
- MolDX/DEX Z-Code registration and payer policy checks
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Why genetic testing claims are denied so often
Genetic testing is one of the most denied areas in healthcare billing. Payers require evidence that the result will change patient management, specific personal or family history criteria, and often genetic counseling before testing. Many tests also need prior authorization, and coverage differs widely between plans.
Coding is equally demanding. Tests may be billed with Tier 1 or Tier 2 molecular pathology codes, genomic sequencing procedure codes, multianalyte assay codes or Proprietary Laboratory Analyses (PLA) codes, and some Medicare contractors require tests to be registered with a DEX Z-Code before claims are paid.
A genetics billing partner checks coverage criteria before the sample is run, assembles the clinical documentation payers need, files authorizations and appeals with medical-necessity letters, and manages patient financial responsibility so labs and clinics are not left with unpaid tests.
Common medical genetics billing challenges
Strict coverage criteria
Payers require specific personal and family history and proof that results affect treatment.
Prior authorization volume
Most commercial plans require authorization for hereditary and genomic tests.
Complex code selection
Choosing between gene-specific, panel, sequencing and PLA codes affects payment and approval.
Test registration requirements
Some Medicare contractors require DEX Z-Code registration for molecular tests.
Out-of-network and patient balances
Many labs are out of network, creating high patient balances and complaints.
Long appeal cycles
Denied tests often need multiple appeal levels with clinical letters.
What a medical genetics billing partner should handle
- Coverage and medical-policy checks before testing
- Prior authorization with clinical documentation
- Molecular, genomic and PLA code selection
- DEX Z-Code and test registration support
- Genetic counseling visit billing
- Claim submission to commercial, Medicare and Medicaid
- Medical-necessity appeal letters
- Patient estimates and financial assistance programs
- Denial trend analysis by payer and test
- Lab and clinic revenue reporting
Key codes in medical genetics billing
| Code(s) | What it covers |
|---|---|
| 81162–81167 | BRCA1/BRCA2 gene analysis, full sequence, deletion/duplication and combinations. |
| 81415 / 81416 | Exome sequence analysis, proband and comparator samples. |
| 81425 | Genome sequence analysis. |
| 81420 | Fetal chromosomal aneuploidy genomic sequence analysis (NIPT). |
| 0001U–0xxxU | Proprietary Laboratory Analyses (PLA) codes for specific branded tests. |
| 81479 | Unlisted molecular pathology procedure. |
Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.
Document medical necessity up front
Collect test requisitions with diagnosis codes, personal and family history, prior test results and genetic counseling notes before running a test. This documentation drives authorization approvals and successful appeals.
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Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.
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We review a sample of your claims and aging report to show where revenue is leaking and what a specialist could recover.
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Shortlist billers with proven medical genetics experience, transparent pricing and verified client reviews.
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Top-rated medical billing companies
Billing companies listed on BillerFirms, ranked by client reviews. Ask each one about their medical genetics experience.
GreenSense Billing is a trusted leader in medical billing and revenue cycle management, providing comprehensive solutions tailored to the unique needs of healthcare providers across the United States. Our mission is to streamline administrative complexities, optimize reimbursements, and enhance financial performance, allowing medical professionals to focus on delivering exceptional patient care. Our Services • We offer end-to-end medical billing and revenue management solutions, including: • Medical Billing & Coding - Accurate claims processing to maximize reimbursements and minimize denials. • Revenue Cycle Management (RCM) - A holistic approach to managing claims, payments, and collections. • Provider Credentialing - Seamless enrollment with insurance networks to ensure timely reimbursements. • Financial Solutions - Data-driven insights and financial reporting to optimize practice...
Let’s face it, medical billing shouldn’t be the most challenging part of running a practice. At Medical Lean Management, we take the chaos out of revenue cycle management so you can get back to what matters: delivering excellent patient care. Based in Corona, California, we’re not just another faceless billing company, we’re your partners in efficiency, here to simplify the financial side of healthcare. Why Us? Because We Get It. Paperwork piles up. Claims get denied. Regulations keep changing. It’s enough to make anyone’s head spin. That’s where we step in. We don’t just process claims, we optimize your entire revenue cycle, cutting through the red tape to get you paid faster and with fewer headaches. Our goal? To make your billing so smooth, you’ll wonder how you ever managed without us. Here’s How We Help: ✔ Fewer Denials, More Revenue - Our precision-driven approach slashes claim den...
Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...
How much does medical genetics billing cost?
Genetics and lab billing is often priced as a percentage of collections, sometimes with a per-claim fee for authorization work because each test requires significant documentation.
Most common. You pay only on money collected.
Predictable for high-volume, low-complexity claims.
Dedicated billers working inside your systems.
Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.
Medical Genetics billing FAQs
Common reasons include missing prior authorization, not meeting the payer’s personal or family history criteria, lack of genetic counseling, wrong code selection and tests considered investigational.
Proprietary Laboratory Analyses codes describe specific branded tests from a single lab and are used instead of general molecular codes when available.
A unique identifier assigned to a molecular test in the MolDX program, required by some Medicare contractors before they pay the claim.
Yes, using the appropriate counseling and E/M codes depending on whether services are provided by a physician or a genetic counselor and payer rules.
Yes, through upfront estimates, payment plans and connecting patients with lab financial assistance programs.
Often 6% to 12% of collections, reflecting the heavy authorization and appeal workload.
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